1.Assymetry of the direction in which nipples point suggests underlying _____.: Cancer

2.At which auscultation point will you listen for gallops (S3, S4) in the left lateral decubitus position?: Mitral

3.At which auscultation point will you listen for physiologic splitting of S2 during inspiration?: Erb's point

4.Bartholin gland infections occur in which gender?: Female!

5.The cervical os marks the opening into the endocervical canal. How does it appear in nulliparous women? How does it appear in women who have given birth?: Nulliparous -- small and round
Parous -- slit-like

13.Diabetic patient presents with crepitus of the scrotum. The scrotum is also swollen and erythematous. Diagnosis?: Fournier's Gangrene

14.Dimpling of the skin of the breast signifies _______.: Breast cancer (probably a carcinoma of the suspensory ligaments)

15.Ejection clicks and opening snaps are best heard with the ______.: Diaphragm

16.Explain the difference between phimosis and paraphimosis.: Phimosis: a tight prepuce that cannot be retracted over the glans
Paraphimosis: a tight prepuce that, once retracted, cannot be returned to cover the glans. Edema ensues.

17.Flattening of a normally convex breast suggests ______.: Cancer

18.For a patient who presents with penile discharge, how will you differentiate between gonorrhea and NGU (non-gonococcal urethritis)?: A culture and a gram stain

19.Galactorrhea is often due to ______. It may also be a side effect of what type of medications?: Prolactinoma
D2 receptor blockers (such as anti-psychotics)

20.Herpes appears slightly differently in males than it does in females. ID the gender of the following infected patients:
1. appear as shallow, small, painful ulcers on red bases
2. appear as smal, scattered or grouped vesicles: 1. Female
2. Male

21.High-pitched sounds are better heard with the _______ and low-pitched sounds are better heard with the _______.: diaphragm (hi, di)
bell

22.How long should capillary refill time be? What might be indicated by a prolonged capillary refill time?: Less than 2 seconds
May indicate dehydration, shock, peripheral vascular disease, or hypothermia

23.How will a patient with non-gonococcal urethritis (NGU) present?: Presents with penile discharge that is clear or white, scanty, and usually observed when inspecting the urethral meatus.

24.ID the following: A herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.: Rectocele

27.If a person has all 4 heart sounds, what order will you hear them in?: 4, 1, 2, 3
ejection click after 1
opening snap after 2

28.If a pilonidal cyst has a small tuft of hair and is surrounded by a halo of redness, what is indicated?: The opening of a sinus tract

29.If you are trying to estimate JVP, what are some ways to differentiate between internal jugular pulsations and the carotid pulse?: Not palpable
Biphasic, undulating quality -- 2 troughs & 2 elevations per heartbeat
height changes with position and falls with inspiration
eliminated by light pressure

30.If you locate a nodule in the breast, how will you describe its location?: By quadrant or clock face, and by distance in cm from the nipple.

31.If your stethoscope has a functional diaphragm, how much pressure do you apply to listen with the bell? The diaphragm?: bell -- light pressure
diaphragm -- press tightly

32.If you suspect __________, you will sniff for fishy odor after applying KOH to a wet mount cervix sample.: Bacterial vaginosis (BV)

33.In an asthmatic patient, wheezes and crackles may be heard, and tactile fremitus is ______.: Decreased

34.In what patient position is aortic stenosis and regurgitation best heard?: With patient sitting up and leaning forward.
For regurgitation, patient should exhale and hold breath.

35.In which patient population is Fournier's (scrotal) gangrene common?: Diabetics

36.Jugular veins empty directly into the _________, so they reflect activity of the ______ side of the heart.: Superior vena cava
Right

37.JVP should be measured at less than ____ cm above the sternal angle, or less than ____ cm in total distance above the RA.: 3-4 cm
8-9 cm

38.The level at which the jugular pulse is visible gives an indication of ______________, which also equals central venous pressure and right ventricular end-diastolic pressure.: right atrial pressure

39.Name three sounds best heard with the bell.: S3, S4, AV valve stenosis

41.New, unilateral nipple inversion or retraction suggests ______. What part of the breast is affected?: Cancer
suspensory ligaments

42.Normally, only the _______ of heart valves can be heard.: Closing

43.On which side of the patient will you examine JVP?: Right

44.Patient presents with an acutely painful, tender, swollen testicle that is retracted upward in the scrotum. The scrotum is red and erythematous. Diagnosis?: Testicular torsion (twisting of the testicle on the spermatic cord)

45.Patients who are hypovolemic will have a ____ JVP. Patients who are hypervolemic will have an _____ JVP.: Low
High

46.Peau d' orange, a sign of breast cancer, results from ________.: lymphatic obstruction, which produces edema of the skin

47.Physiologic splitting of S2 is best heard on _____ and disappears with ________.: inspiration
expiration

48.Presence of a cardiac thrill is indicative of what?: A loud murmur

49.Pulmonic and aortic sounds radiate to which auscultation area?: Erb's point

50.Regurgitation and stenosis of the ______ valve is located at the apex.: Mitral

51.A scrotal varicocele is most common on which side of the body?: Left

52.The sound heard when an AV valve is stenotic is called ________.: opening snap

53.The sound produced when a semilunar valve is stenotic is termed _______.: ejection click

54.The sound that precedes the carotid pulse is ___. The sound that follows the carotid sound is ___.: S1 precedes
S2 follows

56.There are four groups of axillary lymph nodes. Three of them drain into the fourth group, called the ______ nodes.: Central

57.Thickening of the nipple and loss of elasticity suggests _______.: Underlying cancer

58.To measure posterior chest expansion, where should you place your thumbs? Where do you place thumbs for anterior chest expansion?: At the level of the 10th ribs
Along costal margin

59.Upon palpation of the scrotum in a patient, you notice that there is no palpable testis or epididymis. What is the diagnosis? What is this patient at increased risk for?: Dx: cryptorchidism
Increased risk of testicular cancer

60.Vaginal discharge in gonorrhea and chlamydia will have what distinct quality?: Purulent

69.What is the common name for condyloma acuminatum? What is the causal agent?: Genital warts
HPV

70.What is the first heart sound?: closure of AV valves (mitral and tricuspid)

71.What is the most common non-cancerous tumor found in breasts, especially in adolescent females.: Fibroadenoma

72.What is the PE exam order in the thorax? In the abdomen?: Thorax: inspect, palpate, percuss, auscultate
Abdomen: inspect, auscultate, percuss, palpate

73.What is the second heart sound?: Closure of semilunar valves (aortic and pulmonic)

74.What may ensue if PID is left untreated?: A tubo-ovarian abscess, or infertility

75.What percent of breast cancers are found in males?: Less than 1%

76.What results when valves inside the veins along the spermatic cord prevent blood from flowing properly, thus causing the blood to back up, and in turn, causing swelling and widening of the veins?: Varicocele

78.What will you use to palpate for cardiac thrills?: A bony prominence (heads of metacarpals)

79.When performing a breast exam, the examiner palpates in a rectangular area. Name the four borders of that rectangle.: 1. clavicle
2. inframammary fold (bra line)
3. mid-sternal line
4. posterior axillary line

80.When will normal vaginal discharge become more noticeable?: during pregnancy
use of oral contraceptive pills
close to ovulation (mid-cycle)

81.Where is a pilonidal cyst located?: In the midline, superficial to the coccyx or the lower sacrum (right above the "butt crack")

82.Which adventitous breath sound is associated with COPD?: Wheezing

83.Which demographic is at the highest risk for syphilis?: African American and hispanic women

84.Which disease is described?: Red, scaling, crusty skin lesion that usually involves the nipple, areola, and surrounding skin.: Paget's of the breast

85.Which heart sound has two components?: S2

86.Which heart sound is normal in children or young adults but abnormal in people over 40? How is it produced?: S3
As blood flows from atria to ventricles, it distends the ventricular walls and causes vibrations.

87.Which heart sound marks atrial contraction, and thus is NEVER heard in the absence of atrial contraction?: S4
It also reflects a pathologic change in ventricular compliance (increased ventricular stiffness)

88.Which is characteristic of secondary syphilis? A syphilitic chancre, or condyloma latum? Which is the most contagious phase?: Condyloma latum is secondary syphilis - most contagious.
The chancre occurs first.

89.Which is the best validated technique for detecting a breast mass?: Vertical strip pattern

90.Which is the most common murmur?: Midsystolic ejection murmur (produced by turbulence across a semilunar valve)

91.Which is the only murmur that doesn't radiate?: Mitral stenosis

92.Which murmur is best heard with the patient int he left lateral decubitus position, holding breath in exhalation, and stethoscope placed over the PMI?: Mitral stenosis

93.Which murmur is located at the aortic auscultation area?: Aortic stenosis

94.Which murmur is located at the pulmonic, Erb's, and tricuspid auscultation areas?: Aortic regurge

95.Which murmur is the only low-pitched murmur?: Mitral stenosis

96.Which vein is used to estimate JVP?: Right internal jugular vein

97.Why is priapism a medical emergency?: blood flow is occluded and the tissue may become necrotic